title: Reconsidering the wisdom of the body: an epistemological critique of Claude Bernard's concept of the internal environment.
abstract: Claude Bernard's concept of the internal environment (milieu intérieur) played a crucial role in the development of experimental physiology and the specific medical therapeutics derived from it. This concept allowed the experimentalist to approach the organism as fully determined yet relatively autonomous with respect to its external environment. However, Bernard's theory of knowledge required that he find organismic functioning as the result of an external necessity. He is therefore unable to explain adequately the origin or operation of organismic autonomy. A more complete conception of biological autonomy must include a theory of knowledge that can accommodate the organism as a source of discrimination and determination. Only in this way will it be possible to see organisms as active as well as reactive, as ordering as well as ordered. This shift in perspective is crucial if medicine is to be able to characterize, for example, susceptibility to disease. A cognitive sense of the organic interior is proposed as an alternative to Bernard's internal environment.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle 98195.
authors.forename: M D
authors.initials: MD
authors.lastname: Sullivan
mesh_terms: D000818:Animals; D006706:Homeostasis / Q000502:physiology*; D006801:Humans; D010686:Philosophy, Medical; D013812:Therapeutics